Conexão anômala parcial de veias pulmonares com comunicação interventricular: a rara e possível dificuldade na definição anatômica de isomerismo atrial esquerdo

Abstract

Conexão anômala parcial de veias pulmonares com comunicação interventricular: a rara e possível dificuldade na definição anatômica de isomerismo atrial esquerdoPartial anomalous pulmonary venous connection with interventricular communication: the rare and possible difficulty on the anatomic definition of left atrial isomerism CLINICAL DATA 9-month-old male child, 7 kg, born in Fronteira, MG. Born at full-term with 3.3 kg. On the 10th day of life heart murmur was noted, but referred to the pediatric cardiologist with 5 months due to fatigue while breastfeeding, excessive sweating and inappropriate weight gain. With the clinics indicating congenital heart disease with pulmonary hyperflow and congestive heart failure (CHF), chest X-ray, electrocardiogram and echocardiogram were requested, which were complemented by multi-detector computed tomography (MDCT).Under use of digital and diuretic, on the physical examination the patient presented in good general condition, afebrile, acyanotic and with tachydyspnea. Ictus cordis positioned to the right, regular heart rhythm with two clicks, ejection systolic murmur ++/4+ in right middle sternal border. Pulmonary auscultation with sparse bullous rales. Flaccid abdomen, liver at 3 cm from the left costal margin. Pulses were palpable and symmetrical in the four members. ELECTROCARDIOGRAM Sinus rhythm, heart rate 150 beats/min. PR interval of 80ms, QRS 80ms and QT 200ms. Negative P wave in D1, aVL indicating situs inversus totalis. Possible right ventricle overload (Figure 1).